Comparison of the effects of spinal anesthesia, paracervical block and general anesthesia on pain, nausea and vomiting, and analgesic requirements in diagnostic hysteroscopy: A non-randomized clinical trial

Nahid Manouchehrian; Shamim Pilehvari; Farshid Rahimi-Bashar; Farzaneh Esna-Ashari; Shaghayegh Mohammadi

doi:10.3389/fmed.2023.1089497

Comparison of the effects of spinal anesthesia, paracervical block and general anesthesia on pain, nausea and vomiting, and analgesic requirements in diagnostic hysteroscopy: A non-randomized clinical trial

Front Med (Lausanne). 2023 Mar 1:10:1089497. doi: 10.3389/fmed.2023.1089497. eCollection 2023.

Authors

Nahid Manouchehrian¹, Shamim Pilehvari², Farshid Rahimi-Bashar³, Farzaneh Esna-Ashari⁴, Shaghayegh Mohammadi⁵

Affiliations

¹ Department of Anesthesiology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamedan, Iran.
² Department of Gynecology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamedan, Iran.
³ Department of Anesthesiology, Hamadan University of Medical Sciences, Hamedan, Iran.
⁴ Department of Community Medicine, Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamedan, Iran.
⁵ Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamedan, Iran.

Abstract

Background: The aim of this study was to compare the effect of spinal anesthesia (SPA), paracervical block (PB), and general anesthesia (GA), on pain, the frequency of nausea and vomiting and analgesic requirements in diagnostic hysteroscopy.

Methods: This single-center, non-randomized, parallel-group, clinical trial was conducted on 66 diagnostic hysteroscopy candidates who were selected by convenience sampling at Fatemieh Hospital, in Hamadan, Iran, in 2021.

Results: The mean pain score during recovery and the need for analgesic injections was found to be significantly higher in the GA group compared to that in the SPA group (pain: 3.77 ± 2.25 vs. 0.10 ± 0.30, P < 0.001), (analgesic: 50 vs. 0%, P < 0.001) and PB group (pain: 3.77 ± 2.25 vs. 0.90 ± 1.37, P < 0.001), (analgesic 50 vs. 10%, P < 0.001), respectively. However, no statistically significant difference was observed between the mean pain score between SPA and PB groups (0.10 ± 0.30 vs. 0.90 ± 1.3, P = 0.661). In addition, there were no significant differences between groups on nausea/vomiting after operation (P = 0.382). In adjusted regression analysis (adjusting for age, weight, gravid, abortion, and cause of hysteroscopy), the odds ratio (OR) of pain score during recovery was increased in PB (OR: 4.471, 95% CI: 1.527-6.156, P = 0.018) and GA (OR: 8.406, 95% CI: 2.421-9.195, P = 0.001) groups compared with the SPA group. However, in adjusting based on times of surgery duration, anesthesia duration, recovery and return of motor function, the ORs of pain score between groups was not statistically significant.

Conclusion: Despite reduced pain during recovery in patients receiving SPA, duration of anesthesia, recovery period, and return of motor function were significantly prolonged compared to those receiving PB or GA. It seems that PB with less recovery time and faster return of motor function than SPA and also mild pain during recovery compared to GA can be a good option for hysteroscopy.

Clinical trial registration: http://www.irct.ir, identifier IRCT20120915010841N26.

Keywords: anesthesia; general anesthesia; hysteroscopy; paracervical; spinal anesthesia.

Grants and funding

This research was supported by the Hamadan University of Medical Sciences.